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Jan. 17, 2008 -- A 12-week course of talk therapy may help curb the often
debilitating symptoms of panic
disorder -- including intense fear, chest
pain, heart palpitations, and shortness of breath.

The new findings were presented at the annual meeting of the American
Psychoanalytic Association in New York City and published in the American
Journal of Psychiatry.

The psychodynamic psychotherapy regimen used in the study was so successful
that the American Psychiatric Association is in the process of changing its
guidelines to reflect the new findings, according to researcher Barbara Milrod,
MD. Milrod is an associate attending physician at New York-Presbyterian
Hospital/Weill Cornell Medical Center and an associate professor of psychiatry
at Weill Cornell Medical College in New York City.

The twice-weekly sessions are focused on the symptoms of panic disorder as
well as garnering insight about the various unconscious factors that may have
caused the panic disorder to develop in the first place. Such focus on the
unconscious is the basic underpinning of psychoanalysis.

In the new study of 49 people with panic disorder, more than 70% of those in
the talk therapy group showed significantly less anxiety and other panic
symptoms as measured by a standard scale assessing panic symptoms. By contrast,
just 39% of those participants who received applied relaxation training showed
an improvement in their symptoms.

"People really got better -- not just a little better," Milrod says.
Now a large study is under way comparing psychodynamic psychotherapy to
cognitive behavior therapy (CBT) in people with panic disorder, she says.

Comparing Therapies

CBT is also time-limited and aims to change negative thought processes and
modify behaviors. It tends to rely on exposure to triggers and a set
of exercises to help offset attacks. Psychodynamic psychotherapy is aimed
at helping people understand the underlying emotional meaning of their panic
while minimizing the accompanying symptoms.

Other treatments for panic disorder include medication such as selective serotonin reuptake
inhibitors. Medication and therapy can be used together.

"Panic disorder is a treatable condition, and people shouldn't give up
hope just because one of the treatments doesn't work," Milrod says.
"It doesn't mean they won't get better because there are lots of effective
treatments out there."

Chicago-based psychoanalyst Mark Smaller, PhD, the director of the
Neuro-Psychoanalysis Foundation, has seen very good results using psychotherapy
to treat panic disorder.

"Psychodynamic psychotherapy is a step to diffuse the really intense and
debilitating symptoms of panic disorder, and you need that in order for someone
to do more in-depth work or work on issues that contributed to the symptoms in
the first place," he says.